Inpatient Age-Friendly 4Ms Care and Outcomes in an Urban Academic Medical Center

The Age-Friendly Health Systems (AFHS) movement has advanced adoption of the 4Ms (What Matters, Medication, Mentation, and Mobility) framework, but health systems need evidence of whether or not adherence is associated with outcomes. The authors describe an effort that adapted and implemented previously developed electronic health record (EHR)-based 4Ms measures at a large academic medical center. In a retrospective cross-sectional analysis, the authors measured encounter-level adherence to 4Ms care for patients 65 years of age and older hospitalized for more than 24 hours between December 2022 and May 2025. The authors evaluated the association of 100% encounter-level adherence to 4Ms assessments (the Assessment components, i.e., knowing the patient's 4Ms) plus proportions of nursing shifts with 100% of 4Ms actions taken (the Act-On components that incorporate the 4Ms into care delivery, e.g., ambulating, medication reconciliation, etc.) with length of stay (LOS) and odds of discharge to a postacute care (PAC) facility. This study sample included 12,905 unique patients who had 20,512 inpatient encounters. Of those, 36.6% (7504/20,512) met 100% adherence to the Assessment components of the 4Ms. Only 8.4% (1722/20,512) of encounters had 100% adherence to 4Ms Assessment components plus complete adherence to 4Ms Act-On components for 25% of an encounter; 2.8% (581/20,512) had 100% Assessment adherence plus complete adherence to 4Ms Act-On components for 50% of an encounter; and 0.4% (72/20,512) had 100% Assessment adherence plus complete adherence to 4Ms Act-On components for 75% of an encounter. Greater 4Ms adherence was associated with lower postacute facility discharge across the first three adherence thresholds and shorter LOS across all thresholds, with LOS reductions increasing from 1.4 days (95% confidence interval [CI] 1.2 to 1.6) at Assessment plus 25% Act-On to 2.9 days (95% CI, 2.5 to 3.2) at Assessment plus 75% Act-On. These findings suggest that EHR-based 4Ms measurement by AFHS-recognized organizations can help those systems target workflow improvements to support outcome-oriented care delivery for older adults.